The initial challenges in liver transplantation were to demonstrate successful technical outcomes and acceptable long term survival. Now that liver transplantation is a relatively common procedure that provides many life years to the recipient, there must be an intense focus on improvements in cognitive function, health-related quality of life, and cost-utility following transplantation. Due to the achievement of a "ceiling effect" for survival rates and a "floor effect" for graft rejections, additional outcomes measures for liver transplantation must be utilized to measure the effects of interventions. The identification of factors that influence cognitive function, quality of life, and cost-utility is essential to accomplish this goal. The specific aims of this research project are: (1) to prospectively evaluate pre- and post transplant cognitive function and clinical correlates of change in cognitive function following liver transplantation; (2) to test the nature and strength of relationships among pre- and post transplant demographic characteristics, risk factors, and clinical events on functional performance, health-related quality of life, symptoms of anxiety and depression, and overall health in adult liver transplant recipients; and (3) to prospectively assess, and validate in the liver transplantation setting, pre- and post-transplant measures of health status that can be employed in cost- utility analyses. Liver transplant candidates and recipients will be asked to complete a battery of health- related quality of life assessment forms and undergo cognitive function testing at various time intervals to measure the trajectory of change over time and its relationship to multiple pre-operative clinical risk factors, perioperative factors, and post-operative events. The relevance of this research will be the eventual identification of interventions to improve outcomes and to assist clinicians in decision making, much as data on factors that influence survival and complications are employed currently. Findings from these analyses will suggest changes in patient care pathways and the application of resources to influence favorably these important outcome variables, much as patient management strategies have shifted in response to complication rates and causes of mortality in the past. Additionally, this information is likely to influence policy maker and payer decisions, as it will give a more complete picture of anticipated outcomes for individual and groups of patients in relation to this expensive treatment. [unreadable] [unreadable] [unreadable]